| Month | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Site | 1 | 2 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 2 | 1 | 1 |
| Rotation Name | AMB/INP | MGL | AMB/INP | AMB/INP /V | AMB/INP | AMB/INP | AMB/INP | AMB/INP /V | AMB/INP | AMB/INP/R | MGL/R | AMB/INP/R | AMB/INP/R |
| % Outpatient | 75 | 0 | 75 | 75 | 75 | 75 | 75 | 75 | 75 | 25 | 0 | 25 | 25 |
| % Inpatient | 25 | 0 | 25 | 25 | 25 | 25 | 25 | 25 | 25 | 25 | 0 | 25 | 25 |
| % Laboratory | 0 | 100 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 50 | 0 | 0 |
| % Research | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 50 | 50 | 50 | 50 |
Sites
- 1-SLCH/BJH
- 2-Metabolic Biochemical Laboratory
Rotation name
| Rotation | Abbreviation | Total weeks |
|---|---|---|
| Ambulatory Metabolic Service | AMB | 23 |
| Inpatient Metabolic Service | INP | 11 |
| Metabolic Biochemical Laboratory | MBL | 6 |
| Research | R | 8 |
| Vacation | V | 4 |
Notes
- The Medical Biochemical Genetics Fellow will attend the outpatient metabolic clinics based on the percentage indicated in the table (75%: three clinics per week; 25%: one clinic per week). The fellow is expected to work with the metabolic nutritionists to provide continuing care and medical management of chronic patients. The fellow is also expected to provide advice regarding urgent calls from patients/family members/healthcare providers and follow-up and management of abnormal lab tests, including newborn screens.
- The Medical Biochemical Genetics Fellow will be on call for one week per month for a total of 11 weeks. Responsibilities include inpatient rounds with attending and metabolic dietitian, being available for inpatient consults on patients with a potential metabolic disorder, taking calls from parents of ill children with metabolic disorders, arranging for evaluations as needed for an ill patient, taking calls from outside hospitals/physicians regarding patients with metabolic concerns. During this time, the fellow is responsible for coordinating acute management of patients admitted to the Metabolic Service, communicating with patients/families and other health care providers and coordinating discharge planning. The fellow is responsible for providing supervision to Medical Genetics residents. The fellow should coordinate with the residents to pre-round and then arrange a time to round with the attending. The follow is expected during this rotation attend all educational conferences as well as relevant sign out meetings. During the weekends, the fellow takes call from home if there are no inpatients.
- The fellow will spend six weeks in the Metabolic Genetics Laboratory performing and interpreting test results and communicating results to referring clinicians. He will be supervised by the metabolic biochemical laboratory/
- The fellow is expected to complete a research project/scholarly activity, which can be clinical, laboratory-based or a project focused on data mining. Eight weeks will be dedicated to research activities.
- The resident has one day off on the weekend, or has the option to take off both days on the weekend and work the following weekend.
Weekly schedule
Monday
Pre-round on inpatients, follow-up on any calls from outside physicians over the week-end or calls from parents regarding an ill metabolic patient
| 9-10 a.m. | Weekly Transition of Care Conference (NWT 9A) |
| 10:30 a.m. | Inpatient rounds with attending medical geneticist and metabolic dietician |
| 12-1 p.m. | Weekly genetics clinic conference (NWT 9A) |
| 1-2 p.m. | Weekly didactic session (clinical lectures) (NWT 9C) |
| 2 p.m. | Be available for inpatient consults, newborn screening calls, calls from parents of ill children |
Tuesday
Pre-round on inpatients, follow-up on any calls from outside physicians, abnormal newborn screens, any metabolic testing on inpatients, parent calls
| 9 a.m. | Inpatient rounds with attending geneticist and metabolic dietician |
| 10 a.m. | Be available for inpatient consults, newborn screening calls, see add-on patients that need follow-up due to an abnormal newborn screen |
| 12-1 p.m. | Pediatric Case Conference (optional, attend if relevant to biochemical genetics) (Pediatric auditorium, 3rd floor) |
| 1-2 p.m. | Biochemical Genetics Laboratory Sign-Outs |
| 2 p.m. | Be available for inpatient consults, newborn screening calls, see add-on patients that need follow-up due to an abnormal newborn screen |
| 4-5 p.m. | Fellows research conference (Required) (8th floor conference room, MPRB) |
| 5 p.m. | Follow-up as needed on inpatients |
Wednesday
| 7:45 – 8:15 a.m. | Residents Report with Chairman (optional) Humanism in Medicine Series (optional) Quality Improvement Conference and M&M (once monthly) Pre-round on inpatients, follow-up on any calls from outside physicians, abnormal newborn screens, calls from parents of ill children |
| 9 a.m. | Inpatient rounds with attending geneticist and metabolic dietician |
| 10 a.m. | Be available for inpatient consults, newborn screening calls, see add-on patients that need follow-up due to an abnormal newborn screen |
| 1-5 p.m. | Outpatient metabolic clinic |
| 5 p.m. | Follow-up as needed on inpatients, newborn screening calls |
Thursday
Pre-round on inpatients, follow-up on any calls from outside physicians, abnormal newborn screens, calls from parents of ill children
Inpatient rounds with attending geneticist and metabolic dietician (timing is flexible, depending on the attending and their outpatient clinic time)
| 8-12p.m. | Outpatient metabolic clinic |
| 12-1p.m. | Pediatric Molecular Medicine Series |
| 1-5p.m. | Outpatient metabolic clinic |
| 5 p.m. | Follow-up as needed on inpatients, newborn screening calls, outside doctors, parents |
Friday
Pre-round on inpatients, follow-up on any calls from outside physicians, abnormal newborn screens, calls from parents of ill children
| 9:15-10:15 a.m. | Grand Rounds (Cloptin Auditorium) |
| 10:30 a.m. | Inpatient rounds with attending geneticist and metabolic dietician |
| 12-1 p.m. | All-Resident Conference (Wellness Curriculum) |
| 1-2 p.m. | Biochemical Genetics Laboratory Sign-Outs |
| 2-5 p.m. | Research time |
| 5 p.m. | Follow-up as needed on inpatients, newborn screens, calls from outside doctors, parents |
Saturday/Sunday
Round on inpatients as needed
Residents take call from home if there are no inpatients. Responsibilities include being available for inpatient consults on patients with a potential metabolic disorder, taking calls from parents of ill children with metabolic disorders, arranging for evaluations as needed for an ill patient, taking calls from outside hospitals/physicians regarding patients with metabolic concerns.
The resident has one day off on the weekend, or has the option to take off both days on the weekend and work the following weekend. We are flexible and attending’s routinely cover the service on the weekends as needed.
Conference descriptions. All are available to the trainee. Some may be more relevant than others.
Weekly schedule for the Metabolic Genetics Laboratory Rotation
Monday
| 8-12 p.m. | Metabolic Genetics Laboratory |
| 12-1 p.m. | Weekly genetics clinic conference (NWT 9A) |
| 1-2 p.m. | Weekly didactic session (clinical lectures) (NWT 9C) |
| 2-5 p.m. | Metabolic Genetics Laboratory |
Tuesday
| 8-12 p.m. | Metabolic Genetics Laboratory |
| 12-1 p.m. | Pediatric Case Conference (optional, attend if relevant to biochemical genetics) (Pediatric auditorium, 3rd floor) |
| 1-2 p.m. | Metabolic Genetics Laboratory Sign-Outs |
| 2-4 p.m. | Metabolic Genetics Laboratory |
| 4-5 p.m. | Fellows research conference (Required) (8th floor conference room, MPRB) |
Wednesday
| 8-5 p.m. | Metabolic Genetics Laboratory |
Thursday
| 8-12 p.m. | Metabolic Genetics Laboratory |
| 12-1 p.m. | Pediatric Molecular Medicine Series |
| 1-5 p.m. | Metabolic Genetics Laboratory |
Friday
| 8-9 a.m. | Metabolic Genetics Laboratory |
| 9:15 – 10:15 a.m. | Grand Rounds (Cloptin Auditorium) |
| 10:30 – 1 p.m. | Metabolic Genetics Laboratory |
| 1-2 p.m. | Metabolic Genetics Laboratory Sign-Outs |
| 2-5 p.m. | Metabolic Genetics Laboratory |
Morning Conferences
Residents Report (Morning Report)
This daily gathering of the residents promotes leadership by house staff on the wards by allowing residents to discuss recent cases and management. Participants include the pediatric residents, program director, chairman and chief residents. The information generated by brainstorming supports the authority of the supervisory resident as a resource for other team members. Monthly on Wednesdays, the chairman changes focus to an ethical topic discussion or a professionalism topic discussion led by residents.
Evidence-Based Medicine Conference
Evidence-Based Medicine journal clubs are held once monthly in a morning report setting. A group of residents leads the audience via small group discussions through a critical appraisal of a journal article pertaining to a clinical question that arose on service. Faculty mentors and content experts attend the conference to offer guidance and input. These conferences are designed to give residents the tools to conduct effective literature searches and appraise articles in order to make evidence-based clinical decisions.
Quality Improvement Conference
Resident-drive quality improvement conferences are held once monthly. These conferences focus on a clinical event that demonstrated an opportunity on improvement from a systems, knowledge base, or communication level. A quality improvement/patient safety topic is also discussed to allow residents to gain understanding of the process of quality improvement in the hospital.
Grand Rounds
Lectures are on a wide range of topics by Washington University faculty and visitors. These are attended by many members of the St. Louis pediatric community, including full-time faculty, students, house staff, nurses and hospital administrators. Six named lectureships (Hartmann, Dodge, Abelson, Thurston, Strunk and Santiago) provide support for the most sought-after pediatric speakers in the world.
Noon Conferences- lunch provided
Clinical Case Conference (Tuesdays 12-1 p.m.)
Clinical case conferences are an opportunity for faculty and house staff to learn from recent patient presentations. A resident who cared for the patient presents the case, and a faculty member discusses the presentation, diagnosis, and management. Patients with metabolic disorders are presented in this conference and thus, the fellow should attend if the topic is relevant. Examples of previous conferences presented by faculty in Genetics include: Galactosemia, Non-ketotic hyperglycinemia, Isovaleric acidemia, OTC deficiency and others.
All-Resident Core Curriculum Conference
These discussions are led by Washington University faculty physicians and include general pediatrics and subspecialty topics, as well as a yearly emergency series of lectures designed to prepare the residents for acute situations they will face in the hospital.
Pediatric Molecular Medicine Conference
These conferences are led by researchers at Washington University, allowing residents access to cutting edge research that provides a deeper understanding of modern clinical medicine
All-Resident Wellness Conference
These conferences provide a format for residents to unwind and decompress, exploring a variety of issues, including work-life balance, career advancement, humanism in medicine, advocacy projects, and of course, resident favorite “pet therapy”.
Other Educational Activities
Chairman’s rounds
Gary Silverman, MD, PhD, the chair of the Department of Pediatrics holds a discussion with a different team around the hospital. An opportunity for direct interaction in small, patient-oriented sessions with the pediatrician-in-chief provides two-way educational opportunities. The resident benefits from the chairman’s interest in melding scientific advances with clinical problems. The chairman gains firsthand knowledge of the residents.
Many other conferences, not described above, are open to the fellow. These conferences are devoted to neurology, pediatric research, gastroenterology, pathology, radiology, pediatric infectious disease and many other subspecialties.